Treating tendonitis

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How to Treat Elbow Tendonitis (Tennis Elbow or Golfer's Elbow)

By Dr. Ben Kim on January 10, 2009

Elbow tendonitis is a diagnosis that encompasses two common elbow conditions: tennis elbow, and golfer's elbow.

Tennis elbow refers to inflammation of the tendons that attach to the outside or lateral part of the elbow, while golfer's elbow refers to inflammation of the tendons that attach to the inner or medial part of the elbow.

In order to effectively treat either type of elbow tendonitis, you first have to understand what tendons are. Simply put, tendons are the ends of muscles. They allow muscles to attach to bones. Put another way, every major muscle in your body emerges as a tendon from one of your bones and inserts as a tendon into another one of your bones.

In the case of your forearms, the muscles that run down the front of your forearms emerge as tendons from your inner elbow bone, while the muscles that run down the back of your forearms emerge as tendons from your outer elbow bone. All of these muscles insert as tendons into the bones in your wrist and hand.

Take a moment right now to clench both of your fists and feel the muscles that run along the front and back of your forearms contract. With your fists clenched, bend your wrists toward you, so that your palms come closer to you. With your wrists flexed in this position, you should feel a good stretch in the muscles that run along the back of your forearms. You should also feel a mild contraction in the muscles that run along the front of your forearms.

Now, with your fists still clenched, bend your wrists away from you, so that your palms are facing away from you. With your wrists extended in this position, you should feel a mild stretch in the muscles that run along the front of your forearms and a mild contraction in the muscles that run along the back of your forearms.

This exercise of flexing and extending your wrists is meant to allow you to feel how the muscles that surround your forearm are designed to move your wrist joint, not your elbow joint. Your elbow joint is controlled by the muscles that run along your upper arm - your biceps and triceps being the two primary ones.

Why is this point important?

When you have pain and stiffness due to inflammation in the tendons that originate in your elbow region, the focus of treatment should not be in your elbow region. Rather, the focus of treatment should be in your wrist region. More specifically, the best treatment for tennis or golfer's elbow is to rest the wrist joint so that the muscles that control your wrist joint can rest. By resting or even immobilizing your wrist joint, the muscles in your forearms and their emerging tendons in the elbow region can rest and heal.

Many conventional treatment protocols for elbow tendonitis focus on using ice massage or other physical therapy modalities in the elbow region. While such protocols may provide temporary pain relief, they rarely lead to a lasting, full recovery, particularly if the patient fails to rest his or her wrist.

Some treatment protocols call for braces that wrap around the top of the forearm, close to the area where the tendons of your forearm muscles originate. The reasoning for this is that such braces can dampen the pull that wrist activity will have on the tendons in the elbow region. Again, while this protocol may provide temporary relief, it won't provide lasting results without an appropriate period of rest for the wrist.

The bottom line is this: if you find yourself with elbow tendonitis that is accurately diagnosed as tennis or golfer's elbow, the best step you can take to recover as efficiently as possible is to rest your wrist or even wear a solid brace around your wrist for a few days. The brace should be solid enough to prevent conscious and subconscious overuse of the wrist joint, which should give the muscles and tendons in your forearm and elbow, respectively, ample time to rest and heal.

By the way, flexing and extending your wrists as described above but in a slow and deliberate manner a few times each day will keep the muscles and tendons that surround your forearms and elbows strong and flexible and minimize your chances of developing elbow tendonitis.

Addendum: In some cases, chronic elbow tendonitis can be caused by forearm muscles that are hypertonic from overuse. Stretching forearm muscles as described in this article may help restore optimal tone to hypertonic muscles, but in cases where light stretching doesn't lead to improvement, I recommend giving Active Release Technique (ART) a try.

You can visit a practitioner who has experience with ART, or you can perform ART quite easily on your elbow region.

In the case of tennis elbow that is being caused by hypertonic forearm extensors, use the fingers of your unaffected side to palpate the muscles that are closest to the site of your pain. If you have trouble locating these muscles, find the tender bony protuberance near the site of pain on the backside of your elbow, and run your fingers along the muscles in that area. Just a few inches away from the bony protuberance, you'll feel a group of muscles that are likely to be tender when you press into them.

Once you locate these hypertonic muscles, firmly press down into them with the fingers of your unaffected side - apply enough pressure to create some tenderness, and maintain this pressure.

Keep this pressure steady, and slowly bend your wrist forward and backward with your fist loosely clenched - if you clench too hard, you won't get an effective stretch of your forearm muscles. As your wrist bends back and forth, the downward pressure from your fingertips should help to loosen up the hypertonic muscles in your elbow region.

Do this for 30 to 60 seconds at a time, using as much pressure as you can comfortably tolerate. Performing this exercise several times a day should restore healthy tone to your forearm muscles, which can only help in alleviating your elbow area of unnecessary stress.

In the case of golfer's elbow, you can apply the same technique, but instead of using your fingers to press down into hypertonic muscles, it's easier to use the thumb of your unaffected side to apply pressure to your flexor forearm muscles near the bony protuberance that's located on the inner side of your elbow joint.

Please note: Self-administration of Active Release Technique is a simple and highly effective way of treating hypertonic (tight) muscles. Often times, pressure is applied to points on a muscle that correspond to common trigger points that tend to develop in major muscle groups. So one step to becoming proficient with ART is to familiarize yourself with common trigger points that develop in major muscle groups, and to do this, I recommend that you consider the following manual that provides comprehensive coverage of trigger point therapy:

The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition

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